[Congressional Record (Bound Edition), Volume 154 (2008), Part 5]
[House]
[Pages 6521-6523]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   NATIONAL HEALTH CARE DECISIONS DAY

  Mr. DINGELL. Mr. Speaker, I move to suspend the rules and agree to 
the concurrent resolution (H. Con. Res. 323) expressing Congressional 
support for the goals and ideals of National Health Care Decisions Day.
  The Clerk read the title of the concurrent resolution.
  The text of the concurrent resolution is as follows:

                            H. Con. Res. 323

       Whereas National Health Care Decisions Day is designed to 
     raise public awareness of the need to plan ahead for health 
     care decisions related to end-of-life care and medical 
     decision-making whenever patients are unable to speak for 
     themselves and to encourage the specific use of advance 
     directives to communicate these important decisions;
       Whereas the Patient Self-Determination Act (42 U.S.C. 
     1395cc(f) et seq.), guarantees patients the right to 
     information about their rights under State law regarding 
     accepting or refusing medical treatment;
       Whereas it is estimated that only a minority of Americans 
     have executed advance directives, including those who are 
     terminally ill or living with life-threatening or life-
     limiting illnesses;
       Whereas advance directives offer individuals the 
     opportunity to discuss with loved ones in advance of a health 
     care crisis and decide what measures would be appropriate for 
     them when it comes to end-of-life care;
       Whereas the preparation of an advance directive would 
     advise family members, health care providers, and other 
     persons as to how an individual would want to be treated with 
     respect to health care;
       Whereas to avoid any legal or medical confusion due to the 
     emotions involved in end-of-life decisions, it is in the best 
     interest of all Americans that each person over the age of 18 
     communicate his or her wishes by creating an advance 
     directive;
       Whereas the Conditions of Participation in Medicare and 
     Medicaid, section 489.102 of title 42, Code of Federal 
     Regulations (as in effect on the date of enactment of this 
     resolution), require all participating facilities to provide 
     information to patients and the public on the topic of 
     advance directives;
       Whereas the Centers for Medicare and Medicaid Services has 
     recognized that the use of advance directives is tied to 
     quality health care and has included discussions of advance 
     directives in the criteria of the Physician Quality Reporting 
     Initiative;
       Whereas establishing National Health Care Decisions Day 
     will encourage health care facilities and professionals as 
     well as chaplains, attorneys, and others to participate in a 
     collective, nationwide effort to provide clear, concise, and 
     consistent information to the public about health care 
     decision-making, particularly advance directives; and
       Whereas as a result of National Health Care Decisions Day, 
     recognized on April 16, 2008, more Americans will have 
     conversations about their health care decision, more 
     Americans will execute advance directives to make their 
     wishes known, and fewer families and health care providers 
     will have to struggle with making difficult health care 
     decisions in the absence of guidance from the patient: Now, 
     therefore, be it
       Resolved by the House of Representatives (the Senate 
     concurring), That the Congress--
       (1) supports the goals and ideals of National Health Care 
     Decisions Day;
       (2) supports the goals and ideals of advance care planning 
     for all adult Americans;
       (3) encourages each person in the United States who is over 
     the age of 18 to prepare an advance directive to assist his 
     or her loved ones, health care providers, and others as they 
     honor his or her wishes;
       (4) calls upon all members of this body to execute such 
     documents and discussions for themselves; and
       (5) encourages health care, civic, educational, religious, 
     and for- and non-profit organizations to encourage 
     individuals to prepare advance directives to ensure that 
     their wishes and rights with respect to health care are 
     protected.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Michigan (Mr. Dingell) and the gentleman from Georgia (Mr. Gingrey) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Michigan.


                             General Leave

  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and to 
include extraneous material on the resolution under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, at this time, I reserve the balance of my 
time. My good friend from Georgia, I know, has some important comments.
  Mr. GINGREY. Mr. Speaker, I rise today in support of H. Con. Res. 
323, expressing congressional support for the goals and the ideals of 
National Health Care Decisions Day.
  National Health Care Decisions Day was recognized by hundreds of 
organizations across the United States last Wednesday, April 16, and it 
is appropriate for this body to stand with those organizations in 
recognition of this important day.
  Mr. Speaker, first of all, though, I want to thank the distinguished 
chairman of the Energy and Commerce Committee, Mr. Dingell, and his 
staff for their cooperation in helping us get this to the floor. I want 
to thank the ranking member, Mr. Barton, and the minority staff and the 
100 Members, many of them members of the Energy and Commerce Committee 
who are cosponsors of this resolution.

[[Page 6522]]

  Mr. Speaker, the goals of the resolution are twofold. First, it aims 
to raise awareness of the importance for everyone at all stages of life 
to take the time to discuss important end-of-life medical decisions 
with their loved ones.
  Second, this resolution recognizes the emphasis of over 450 
organizations spanning all 50 States that worked together on April 16 
to educate Americans about their options in preparing advanced medical 
directives and appointing medical powers of attorney.
  Of these groups, 75 are national organizations, including AARP, the 
American Bar Association, the American Medical Association, National 
Right to Life, and an additional 370 State and community organizations 
participated in the National Health Care Decisions Day efforts.
  Mr. Speaker, as a result of the National Health Care Decisions Day, 
thousands of people across the country have received information on 
advanced directives through newspaper articles, television, and radio 
broadcasts, all released last week on April 16. I want to thank and 
congratulate all those involved for their hard work on this important 
cause. I am also proud of the broad bipartisan support this resolution 
has garnered.
  Companion legislation sponsored by Senators Wyden and Enzi has 
already passed the Senate, and now over 100, as I mentioned earlier, of 
my fellow House Members of both sides of the aisle have signed on to 
this resolution.
  Mr. Speaker, I want to urge the American people to invest time and 
effort into seeking out information on advanced directives. Advanced 
directives allow individuals to maintain control over their health care 
decisions even at the end of their lives, regardless of the 
circumstances they may face at that time. And I also encourage 
Americans to educate themselves on the options and details of the 
various types of advanced directives so that their wishes may be 
correctly documented and carried out.
  Let me be very clear: This bill does not express what an individual's 
end-of-life decision should be. Those are the decisions that should be 
left to the individual undertaking this difficult but important step.
  This resolution merely seeks to raise awareness about advanced 
directives themselves. And that's why this resolution is being 
supported by such a diverse range of organizations. Educating 
individuals and making them aware of their choices is a key to 
respecting and preserving life.
  Mr. Speaker, as a physician, I cannot stress enough that these 
decisions should be made with the input of medical professionals and 
should be accessible to the patient's doctor in the time of greatest 
medical need. Too many times, families are left to guess what medical 
decisions their family member would have wanted. Think about the Terri 
Schiavo case a couple years ago. But physicians are sometimes left to 
guess as well.
  A recent study by the U.S. Agency for Health Care Research and 
Quality found that 75 percent of physicians whose patients had advanced 
directives were not even aware that those directives existed. This is a 
problem, Mr. Speaker, and I hope that as we get electronic medical 
records and HIT, Health Information Technology, becomes more 
sophisticated and intraoperable, these advanced directives can be 
stored electronically and be made accessible to the medical staff in an 
instant, really, in a timely manner.
  So, in conclusion, Mr. Speaker, I want to encourage all Americans to 
set aside time to have what may very will be one of the most vital 
conversations that any family can have.
  I urge my fellow Members to vote in support of this resolution and to 
recognize the critical role of education in allowing Americans to 
effectively express their end-of-life wishes.
  With that, Mr. Speaker, I reserve the balance of my time.
  The SPEAKER pro tempore. Without objection, the gentleman from New 
York (Mr. Towns) will control the time.
  There was no objection.
  Mr. TOWNS. Mr. Speaker, I yield myself as much time as I may consume.
  Mr. Speaker, I rise in strong support of H. Con. Res. 323, expressing 
congressional support for the goals and ideals of National Health Care 
Decisions Day.
  As a cosponsor of this resolution, I understand the importance of 
making our health decisions clear to our family members and other loved 
ones through advanced directives. While it is very difficult for us to 
face the prospects of our own mortality, many of us write wills in 
order to ensure that our loved ones are adequately provided for in our 
absence. Unfortunately, we often do not take that care in making 
provisions regarding our end-of-life medical care.
  Nobody can predict when disease, tragedy, or other medical conditions 
will render one unable to make medical decisions for ourselves. 
Accordingly, we must plan ahead in case of such a tragedy to ensure 
that our wishes are properly carried out.
  Advanced directives are an integral part of any care-delivery plan. 
They are simply a statement by a competent person that articulates the 
medical, legal, and personal wishes regarding medical treatment in the 
event of future incapacity.
  Where advanced directives are present, medical professionals, 
families, and loved ones are best able to make critical care decisions 
should a patient become unable to make sound judgments about their 
health care.
  The resolution before us commemorates National Health Care Decisions 
Day on April 16, 2008. Although this specific day occurred last week, 
the goals and ideals of today should be recognized perpetually.

                              {time}  1445

  This resolution encourages those 18 years of age and older to prepare 
advance directives. It also encourages medical, civic, educational, 
religious and other nonprofit organizations to promote advance 
directive preparation, particularly among their constituents.
  I would like to thank my colleague on the other side of the aisle, 
Representative Phil Gingrey, for his work in raising this important 
issue. Our colleagues in the Senate have already recognized the need to 
highlight advance directives, and I urge us here in the House to do the 
same.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GINGREY. Mr. Speaker, I just want to thank my friend from New 
York for his support of this resolution. And again, I want to thank the 
chairman of the committee, Mr. Dingell, for allowing this to be brought 
to the floor under suspension and for his support, and for the support 
of the majority staff, and also to my distinguished colleague, the 
ranking member of Energy and Commerce, Representative Barton, and the 
minority staff.
  I urge all of my colleagues to support the resolution, as 
Representative Towns just said.
  Mr. Speaker, I yield back the balance of my time.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in strong support 
of H. Con. Res. 323, expressing Congressional support for the goals and 
ideals of National Health Care Decisions Day. I would first like to 
thank my distinguished colleague Phil Gingrey of Georgia for 
introducing this important piece of legislation. This legislation 
recognizes an important initiative to encourage patients to express 
their wishes regarding healthcare and for providers and facilities to 
respect those wishes, whatever they may be.
  National Health Care Decisions Day is designed to raise public 
awareness for the need to plan ahead for health care decisions related 
to end-of-life care and medical decision-making whenever patients are 
unable to speak for themselves and to encourage the specific use of 
advance directives to communicate these important decisions. The 
Federal Patient Self-Determination Act requires that all Medicare-
participating healthcare facilities inquire about and provide 
information to patients on Advance Directives; it also requires these 
facilities to provide community education on Advance Directives (42 
C.F.R. Sec. 489.102). All healthcare facilities are required to: 
provide information about health care decision-making rights; ask all 
patients if they have an advance directive; educate their staff and 
community about advance directives; not discriminate against patients 
based on an advance directive status.

[[Page 6523]]

  It is estimated that only a minority of Americans have executed 
advance directives, including those who are terminally ill or living 
with life-threatening or life-limiting illnesses. Advance directives 
offer individuals the opportunity to discuss with loved ones in advance 
of a health care crisis and decide what measures would be appropriate 
for them when it comes to end-of-life care. The preparation of an 
advance directive would advise family members, health care providers, 
and other persons as to how an individual would want to be treated with 
respect to health care. Forty-two percent of Americans have had a 
friend or relative suffer from a terminal illness or coma in the last 5 
years and for a majority of these people and 23 percent of the general 
public, the issue of withholding life sustaining treatment came up. An 
overwhelming majority of the public supports laws that give patients 
the right to decide whether they want to be kept alive through medical 
treatment. By more than eight-to-one (84 percent-10 percent), the 
public approves of laws that let terminally ill patients make decisions 
about whether to be kept alive through medical treatment. One of the 
most striking changes between 1990 and 2005 is the growth in the number 
of people who say they have a living will--up 17 points, from 12 
percent in 1990 to 29 percent now.
  Patients and families are often not fully informed of the relevant 
risks and potential benefits of artificial nutrition and hydration 
(ANH). In addition, financial incentives and regulatory concerns 
promote the use of ANH in a manner that may be inconsistent with 
medical evidence and with the preferences of patients and their 
families. Because ANH is associated with uncertain benefits and 
substantial risks, it is essential to ensure that decisions about its 
use are consistent with the patient's medical condition, prognosis, and 
goals for care. Therefore, decisions about ANH require careful 
consideration of its risks and potential benefits.
  Establishing National Health Care Decisions Day will encourage health 
care facilities and professionals as well as chaplains, attorneys, and 
others to participate in a collective, nationwide effort to provide 
clear, concise, and consistent information to the public about health 
care decision-making, particularly advance directives. As a result of 
National Health Care Decisions Day, recognized on April 16, 2008, more 
Americans will have conversations about their health care decision, 
more Americans will execute advance directives to make their wishes 
known, and fewer families and health care providers will have to 
struggle with making difficult health care decisions in the absence of 
guidance from the patient.
  I strongly urge my colleagues to join me in supporting this important 
piece of legislation.
  Mr. TOWNS. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Michigan (Mr. Dingell) that the House suspend the rules 
and agree to the concurrent resolution, H. Con. Res. 323.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the concurrent resolution was agreed to.
  A motion to reconsider was laid on the table.

                          ____________________